Sheena Byrom and the moral bankruptcy of UK midwifery

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Once again I have written a blog post about my revulsion at the deadly behavior of UK midwives, and once again a prominent midwife has rushed to demonstrate the truth of my words to the entire world: professional autonomy is more important to midwives than whether babies live or die.

It was only 4 days ago that I wrote about the latest Stunning indictment of UK midwives. According to The Guardian:

Sheena Byrom is the poster child for moral depravity in the face of preventable infant deaths.

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures …

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion].

The proximate cause is that UK midwives are not adequately trained in fetal monitoring, but the real cause is that UK midwives place process (“normal birth”) above outcome (live, healthy babies and mothers).

Just in case you thought I was exaggerating the immorality of a group of medical providers who place their personal philosophy above the lives they are ethically mandated to protect, midwife Sheila Byrom rushes to prove me right.

Byrom is the poster child for moral depravity in the face of preventable infant deaths. She has the unmitigated gall to defend the unethical behavior of midwives in privileging process over outcome by arguing that it is more important to preserve “normal birth” than human life.

In my piece I asked: how many babies have to die and how many billions of pounds have to be paid out before the morally repugnant, incompetently trained, self-dealing, deadly UK midwives are held to account?

Sheena Byrom, writing in conjunction with another deadly midwifery enabler, Soo Downe, answered: as many as UK midwives damn well please.

In Normal birth – a moral and ethical imperative, Byrom and Downe are attempting to rebut a piece in The London Times, Midwives told to stop pushing own agenda for natural births, which notes:

Midwives will be told not to use language that could push women into “normal” birth amid fears that babies are at risk because of a reluctance to ask for medical help…

A review into the deaths of 11 babies and one mother at the Morecambe Bay trust warned that a desire for normal birth “at any cost” was a contributor.

Outgoing head of the Royal College of Midwives (RCM) Cathy Warwick has met every new midwifery scandal with weasel words but no action. Speaking of the most recent scandals, Warwick offered more weasel words:

[I]f there were midwives who were pushing normal birth then we must have good governance process in place which will pick up that and make sure it doesn’t continue to happen.

Byrom and Downe also use weasel words:

Promoting normal birth while also maximising the wellbeing of mother and baby is therefore not a cult, or a professional project, or a conspiracy. It is a moral and ethical imperative, that should be supported by all of those with any interest in the wellbeing of mothers, babies and families, in the short and longer term. This includes professionals, journalists, politicians, health service managers, childbirth activists, and lawyers.

But no one is talking about promoting normal birth while maximizing wellbeing of mother and baby; the issue is promoting normal birth above maximizing wellbeing of mothers and babies.

Byrom and Downe present a graph that demonstrates a slowly rising C-section rate and ask:

And if there is a widespread problem where midwives ‘pursue normal birth at any cost’, why are the statistics below so stark? Surely, the opposite would be the case?

Which words in “claims for brain damage and cerebral palsy has tripled in a decade” and “maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion]” are they having trouble understanding?

Byrom and Downe insist that “normal birth” is a moral and ethical imperative.


Medical ethics rests on four principles:

Respect for autonomy – the patient has the right to refuse or choose their treatment.

Beneficence – a practitioner should act in the best interest of the patient.

Non-maleficence – to not be the cause of harm…

Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment …

Do you see normal birth — or any specific procedure — among these? I don’t either.

The key to understanding midwives’ insistence on a procedure instead of an outcome is to recognize that when midwives say “normal birth” what they really mean is “anything midwives can do and nothing they cannot.” Promoting normal birth is really about promoting midwife autonomy.

In their first paragraph Byrom and Downe make it clear that this is really about midwives and their desires:

Yes, there needs to be learning from incidents, and development where needed. But blaming one professional group, or a particular type of birth, does little to improve any situation.

Actually, insisting that a professional group take responsibility for their own deadly mistakes does A LOT  to improve any situation.

I regularly spend time with student midwives from around the UK and beyond. They tell me they are worried about practising as qualified midwives, as, during their training, they hardly ever see women who have had a normal, physiological, straightforward pregnancy, labour and birth.

Midwifery is NOT supposed to be about meeting midwives’ needs; there is a moral imperative to meet PATIENTS’ needs.

Recent press reports add to the fear already embedded in maternity services. This fear is real in high income countries, and influences the decisions of women, mothers and families alike.

But the ethical provider SHOULD feel fear at the thought of preventable deaths. It is only the morally bankrupt who would counsel otherwise.

Byrom, Downe and Warwick have blood on their hands and the reason is very simple: they continue to promote THEIR interests — the process of “normal birth” (or, more accurately, midwife autonomy) — above safe outcomes for mothers and babies.

As long as UK midwives are allowed to indulge their desire to serve their own interests, babies will continue to die and the NHS will continue to pay out billions of pounds to grieving parents. That is truly immoral and unethical.